Healthcare Provider Details

I. General information

NPI: 1164489258
Provider Name (Legal Business Name): ALFREDO STABNICK NINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 CONSTITUTION PL NE STE 202
ALBUQUERQUE NM
87110-7640
US

IV. Provider business mailing address

8020 CONSTITUTION PL NE STE 202
ALBUQUERQUE NM
87110-7640
US

V. Phone/Fax

Practice location:
  • Phone: 505-998-3096
  • Fax: 505-998-3100
Mailing address:
  • Phone: 505-998-3096
  • Fax: 505-998-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number37790
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD2021-1181
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: